You are receiving this Privacy Notice because you are enrolled in one or more of the Medical, Prescription Drug, EAP, Dental, or Vision Plans (hereafter each is called a "Health Plan") sponsored by Hercules Incorporated or an affiliate. Each Health Plan and Hercules as the Health Plan Sponsor, are committed to protecting the confidentiality of any protected health information we receive in connection with the operation and administration of the Health Plan. This Notice describes how the Health Plan may use and disclose your protected health information. It also describes how Hercules as the Health Plan Sponsor may use or disclose your protected health information.

Protected health information is any information created or received by a health care provider, health plan, employer or health care clearinghouse that relates to your past, present or future physical or mental health or condition, or provision of or payment for health care. Protected health information is information that identifies an individual or may reasonably be used to identify an individual.

Employees of Hercules who administer and manage the Health Plan may use your protected health information only for appropriate plan purposes (such as for payment or health care operations), but not for other purposes not related to the Health Plan, and not for purposes related to your employment by Hercules or an affiliate. Those who administer the Health Plan must comply with the same requirements that apply to the Health Plan to protect the confidentiality of protected health information.

The Health Plan is required by the Health Insurance Portability and Accountability Act (HIPAA) to provide this Notice to you. Additionally, the Health Plan is required by law to:

• maintain the privacy of your protected health information, and
• provide you with a Privacy Notice of its legal duties and privacy practices with respect to your protected health information, and
• follow the terms of a Privacy Notice that is currently in effect.

The Health Plan is permitted by law to use and disclose your protected health information in certain ways. These are described below, with examples of permitted uses. This Notice does not list every permitted use or disclosure the Health Plan may make. However, all of the ways the Health Plan or the Health Plan Sponsor is permitted to use or disclose protected health information will fall within one of the categories below.

1. Treatment Purposes: The Health Plan may disclose protected health information to a health care provider for the health care provider’s treatment purposes, although it is more likely a health care provider would receive your protected health information from another health care provider than from the Health Plan. For example, if your Primary Care Physician (PCP) or your treating medical provider refers you to a specialist for treatment, the Health Plan can disclose your protected health information so the specialist to whom you have been referred so (s)he can become familiar with your medical condition, prior diagnoses and treatment, and prognosis.
    

2. Payment Purposes: The Health Plan may use your protected health information to evaluate and process any requests for coverage and claims for benefits you make, and may review protected health information included with claims to reimburse providers for treatment and services rendered. Additionally, the Health Plan may disclose protected health information to another group health plan or to a health care provider for the payment purposes of the Health Plan, the other group health plan, or the health care provider. For example, the Health Plan can disclose your protected health information to another health plan or payer for purposes of coordinating payment of benefits.
    

3. Health Care Operations Purposes: The Health Plan may use protected health information for its own health care operations and may disclose protected health information to another group health plan, a health care provider, a medical group or a hospital for the health care operations purposes of this Health Plan, or for certain health care operations purposes of the other entities. Examples of the Health Plan’s "health care operations" include underwriting, premium rating and other activities related to plan coverage; conducting quality assessment and improvement activities; submitting claims for stop-loss coverage; conducting or arranging for medical review, legal services, audit services, and fraud and abuse detection programs; and business planning, management and general administration of Health Plan.
    

4. To a Business Associate of the Health Plan: The Health Plan may disclose protected health information to a Business Associate of the Health Plan, if a valid Business Associate Agreement is in place between the Business Associate and the Health Plan. A Business Associate is an entity that performs a function on behalf of the Health Plan and that uses protected health information in doing so, or provides services to the Health Plan such as legal, actuarial, accounting, consulting or administrative services. Examples of Business Associates include the Health Plan’s Third-Party Administrators (TPA), such as CIGNA or AETNA, and its broker.
    

5. To the Health Plan Sponsor: If the Health Plan Sponsor (Hercules or an affiliate), has amended its plan document as required by the Privacy Rule, certified to the Health Plan as required by the Privacy Rule, and established certain safeguards and firewalls to limit the classes of employees who will have access to protected health information and to limit the use of protected health information to plan purposes and not for non-permissible purposes. Any disclosures to the Health Plan Sponsor must be for purposes of administering the Health Plan. Examples would include: for claims appeals to the Plan’s Benefits Committee, for case management purposes, or to Hercules Human Resources representatives who are assisting plan members in getting their claims resolved. Hercules does not routinely maintain medical information concerning treatment, illnesses or diseases in company records. Protected health information is requested only from the Insurers and TPAs for the purposes stated above.

The Health Plan may disclose enrollment/disenrollment information to the Health Plan sponsor, for participant eligibility purposes only, and may disclose "summary health information" which does identify any individual’s protected health information to the plan sponsor for the purpose of obtaining premium bids or modifying or terminating the plan.

6. Where Required by Law or Requested as Part of a Regulatory or Legal Proceeding: The Health Plan may disclose protected health information as required by law or when requested as part of a regulatory or legal proceeding. For example, Health Plan may disclose medical information when required by a court order in a litigation proceeding, or pursuant to a subpoena, or as necessary to comply with Workers’ Compensation laws.
    

7. For Public Health Activities or to avert a Serious Threat to Health or Safety: The Health Plan may disclose protected health information to public health authorities for purposes such as preventing or controlling diseases, injury or disability; reporting abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration on products and reactions to medications; and reporting disease or infection exposure.
    

8. For Law Enforcement or Specific Government Functions: The Health Plan may disclose protected health information to law enforcement personnel for purposes such as identifying or locating a suspect, fugitive, material witness or missing person; complying with a court order or subpoena; and other law enforcement purposes.

Other uses and disclosures of protected health information will be made only with your written authorization or that of your legal representative, and you may revoke such authorization as provided by section 164.508(b)(5) of the Privacy Rule. Any disclosures that were made when your Authorization was in effect will not be taken back.

You have the following rights with respect to your protected health information. To submit one of the requests listed below, you must submit a written request to:

Hercules Incorporated
Hercules Plaza
1313 N. Market Street
Wilmington, Delaware 19894
Attn: HIPAA Compliance Officer

1. The right to inspect and copy protected health information, as provided by section 164.524 of the Privacy regulations.
    

2. The right to request restrictions on certain uses and disclosures of protected health information, as provided by section 164.522(a) of the Privacy regulations (although the Health Plan is not required to agree to a requested restriction).
    

3. The right to receive confidential communications of protected health information by a different means or at a different location, if you believe the Health Plan’s usual method of communicating protected health information may endanger you and the request continues to allow the Health Plan to collect premiums and pay claims, as provided by section 164.522(b) of the Privacy regulations.
    

4. The right to amend protected health information you feel is incorrect, as provided by section 164.526 of the Privacy regulations. The Health Plan may deny your request, but must respond to you in either case.
    

5. The right to receive an accounting of disclosures we have made of your protected health information, as provided by section 164.528 of the Privacy regulations. We are not required to, and we will not, account for disclosures made for treatment, payment or health care operations, national security, law enforcement or to corrections personnel, pursuant to your Authorization, or to you. Please note the time period for which you want an accounting, and the format in which you wish to receive it (e.g., paper or electronically). Note that we will not account for disclosures made more than six years prior to your request, nor for disclosures made before HIPAA became effective for Health Plan (April 14, 2003). We will provide one accounting of disclosures free of charge once every twelve months.
    

6. The right to file a complaint if you feel your privacy rights have been violated. For details, see subsequent section of this Privacy Notice entitled "The Health Plan’s Grievance Procedures."
    

7. The right to receive a paper copy of this Notice of Privacy Practices upon request to the Health Plan Sponsor, even if you have previously agreed to receive this Notice electronically.

The Health Plan is a "covered entity" and has responsibilities under HIPAA regarding use and disclosure of protected health information. The Health Plan has a legal obligation to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices with respect to protected health information. The Health Plan is required to abide by the terms of the current Notice of Privacy Practices (the "Notice"). The Health Plan reserves the right to change the terms of this Notice at any time and to make the revised Notice provisions effective for all protected health information the Health Plan maintains, even protected health information obtained prior to the effective date of the revisions. If the Health Plan revises its Notice, it will notify you of these changes by first class mail or by a personal electronic mailing or by posting on the Human Resources Web Site.

THE EFFECTIVE DATE OF THIS NOTICE IS APRIL 14, 2003.

If you believe your protected health information has been impermissibly used or disclosed, or that your privacy rights have been violated in any way, you may file a complaint with the Health Plan, the Health Plan Sponsor or with the Secretary of Health and Human Services (HHS). You may register a complaint in writing to the address below:

Hercules Incorporated

Or Department of Health and Human Services

The Hubert H. Humphrey Building
200 Independence Avenue, S.W.
Washington, D.C. 20201

Additionally, you can file a complaint with the Secretary of HHS at the following addresses: www.hhs.gov/ocr

You will not be retaliated against for filing a complaint.

If you have questions about any part of this Privacy Notice or if you want additional copies of the Privacy Notice or more information about the privacy practices of the Health Plan or the Hercules as the Plan Sponsor, please contact the HIPAA Compliance Officer listed below.

Hercules Incorporated

Hercules Plaza
1313 N. Market Street
Wilmington, Delaware 19894
Attn: HIPAA Compliance Officer